JK SCIENCE
EDITORIAL
Care of Low Birth Weight Neonates
Ravinder K. Gupta
According to WHO a newborn baby weighing less
than 2500gm at birth is designated as low birth weight
(LBW) neonate. Low birth weight in a newborn infant
results due to intrauterine growth restriction (IUGR) or
prematurity. According to UNICEF, the incidence of
LBW neonates is 30% in India (1,2). Low birth weight
neonates are further classified as very low birth weight
(VLBW <1500 g) and extremely low birth weight (ELBW
<1000 g) infants. The term micro preemie is being applied
for babies being below 500-gram birth weight babies.
The magnitude of LBW babies in developing world is
enormous. Out of a total of 22million such infants in the
world, 21 million belong to the developing countries.
India’s share is quite substantial: 7-10 million. Majority of
LBW neonates in our country weigh between 2000-2499
gms. Around three fourths of them are delivered at full
term of gestation (2,3). This shows that the major low
birth weight problem in India stems from intrauterine
growth retardation and not prematurity, in contrast to the
western world.
LBW is the most significant factor contributing to
neonatal mortality and morbidity. There is higher risk of
asphyxia, sepsis, hypothermia, and feeding problems, etc.
in these neonates. Common illnesses tend to be more
severe and last longer in this group. Apart from immediate
problems, LBW neonates are prone to long-term disorders
like infections, malnutrition, and neurodevelopment
disabilities. Babies who are small or disproportionate at
birth also have an increased risk of developing coronary
heart disease, non-insulin dependent diabetes mellitus,
stroke, hypertension during adult life (2,3). The measures
to increase the birth weight of babies constitute a priority
area in developing nations.
The etiology of LBW is multifactorial. Maternal
malnutrition and anemia are the most important causes
From the Department of Pediatrics , ASCOMS, Sidhra Jammu-J&K-India
Correspondence to : Dr Ravinder K.Gupta, Associate Proff, Deptt. of Pediatrics , ASCOMS, Sidhra Jammu-J&K-India
158
responsible for reduced birth weight in developing nations.
Other maternal factors playing a part include young age
at conception, multiple pregnancies, pregnancy induced
hypertension, infections, substance abuse etc. Genetic
factors also play a role (2-4).
The care of LBW neonate should commence in utero
and be focused on preventive aspects. The impact of
maternal nutritional supplementation in augmenting birth
weight has been studied and documented. The
micronutrients rich food influences the weight of a
neonate. Folic acid supplement during pregnancy has been
shown to improve birth weight (4). Improving the
nutritional status of mother and tackling anemia in
adolescent girls can go a long way in preventing birth of
low birth weight infants.
Labor and vaginal delivery is not being tolerated
frequently by Small for Gestational Age (SGA) infants.
There is an increased incidence of low APGAR scores
at all gestational ages and resuscitation is most of the
times needed. A team trained and skilled in neonatal
resuscitation should be present when a LBW neonate is
being delivered. In addition, the LBW-SGA infants have
a narrow thermo neutral range. The large head to body
ratio and greater surface area along with a thin layer of
subcutaneous fat leads to a rapid heat loss. On the other
hand, the heat production is also compromised due to
hypoglycemia, and hypoxia. It is thus critical that the
LBW-SGA neonate is resuscitated and nursed in a thermo
neutral environment. The resuscitation must be prompt
and the neonate dried and placed under a warmer. The
neonate should be covered well there after (3).
The nutritional management of LBW-SGA neonates
is complex. A rapid glucose supply can lead to
hyperglycemia, but amino-acid intolerance is not
exaggerated. There is reluctance in feeding SGA infants
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as aggressively as their deprived state would indicate. It
needs to be ascertained, if aggressive feeding is tolerated
and whether it results in nutritional rehabilitation and a
better outcome. Breastfeeding in LBW infants is
associated with lower mortality rates and better weight
gain with lower morbidity rates. For infants on expressed
breast milk, feeding with spoon or paladai is
recommended to ensure better hygiene .Trophic feeding
the practice of feeding very small amounts of enteral
nutrition to VLBW babies to stimulate development of
immature gastrointestinal tract .The benefits of trophic
feeding include enhanced gut motility, improved growth,
decreased need for parentral nutrition fewer episodes of
sepsis and short hospital stays.
Early hypoglycemia results due to the diminished
hepatic and skeletal muscle glycogen content and reduced
alternate energy substrates along with deficient counter-
regulatory hormones. There should be frequent
monitoring of blood glucose of these babies and the
concentration maintained above 50 mg/dL. Early enteral
feeds or intravenous glucose for those with clinical
problems must be instituted, preferably within half an hour
of life. Although hypoglycemia is a major problem of LBW
neonates, yet a contrast situation may result in
hyperglycemia due to low insulin secretion rates or
iatrogenically due to high rates of glucose infusion (5, 6).
This condition is usually noted in ELBW (preterm)
neonates or stressed neonates.
Kangaroo mother care (KMC) is a humane, low cost
and simple method of care of LBW infants particularly
for those weighing less than 2000 grams at birth which
can be continued even at home. It consists of skin-to-
skin contact, exclusive breastfeeding and early discharge
with an adequate follow up. Despite said advantages
of KMC, it is not a widely practiced method of care
of LBW infants in India (7, 8).
Vol. 10 No. 4, Oct- Dec 2008
Deficiency of both T and B cell function has been
demonstrated in the babies that are responsible for
diminished immune function. This predisposes them to
neonatal infection. Early diagnosis, treatment, and prevention
through hand washing and universal precautions are
recommended. Limiting nurse to patient ratios and avoiding
crowding, meticulous skin care and appropriate advancement
of enteral feeding and health education are other methods
to reduce the chances of sepsis (3).
LBW neonates are a special group that needs attention
and care. Since the etiology is multifactorial, efforts at a
multipronged approach alone could help achieve targets.
Simple measures to prevent morbidity and mortality as
care of LBW must be exercised with emphasis on skilled
attendance at birth, prompt resuscitation, adequate
nutrition though breast feeding, prevention of hypothermia
through KMC and successful referral of sick neonates.
References
1. United Nations Childrens Fund (UNICEF). The State of
the World’s Children 2004. New York; Unicef: 2003.
2. Gupte S. Chowdhary J, Vani S. Neonatology. In Gupte
S(ed) The short textbook of pediatrics 10th edn.New Delhi.
JayPee Brothers 2004.pp. 614-16.
3. Stoll J B, Chapman I A. The high-risk infant. In Kliegman R
M, Jenson HB,Behrman RE, Stanton B F (eds) Nelson
Textbook of Pediatrics 18th edn. Vol.1. Philadelphia,
Saunders 2008.pp. 698-711
4. Gupta P, Ray M, Dua T, Radhakrishnan G, Kumar R,
Sachdev HPS. Multimicronutrient supplementation for
undernourished pregnant women and the birth size of their
offspring: A double blind, randomized, placebo controlled
trial. Arch Pediatr Adolesc Med 2007; 161: 58-64.
5. Hays S P,Smith E O, Sunehag A L.Hyperglycemia is a risk
factor for early death and morbidity in extremely low birth
weight infants. Pediatrics 2006; 118:1811-18.
6. Kairamkonda VR, Khashu M. Controversies in the
management of hyperglycemia in the ELBW infant.
Ind Pediatr 2008; 45: 29-38
7. Suman Rao PN, Udani R, Nanavati R. Kangaroo mother
care for low birth weight infants: A randomized controlled
trial. Indian Pediatr 2008; 45: 17-23.
8. Kadam S, Binoy S, Kanbur W et al. Feasibility of Kangaroo
mother care in Mumbai. Ind Pediatr 2005; 72:35-38.
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